U.S. patent number 4,227,537 [Application Number 05/884,634] was granted by the patent office on 1980-10-14 for endometrial brush with slidable protective sleeve.
This patent grant is currently assigned to Tucson Medical Instruments, Inc.. Invention is credited to Herbert J. Schmidt, Thomas N. Suciu.
United States Patent |
4,227,537 |
Suciu , et al. |
October 14, 1980 |
Endometrial brush with slidable protective sleeve
Abstract
An endometrial brush and method of using, the endometrial brush
including a slidable protective sleeve for protecting bristles of
the endometrial brush from wetting and contamination by cervical
tissue during insertion of the endometrial brush through the cervix
and into the endometrial cavity of the patient. The protective
sleeve is composed of tubular flexible material which is slid
forward along a shaft of the endometrial brush to cover the
bristles during insertion. After the bristle section of the brush
is in its desired position in the endometrial cavity, the
protective sleeve is slid backward along the shaft, thereby
uncovering the bristles. The handle is then manipulated to cause
the bristles to scrape the walls of the endometrial cavity, thereby
collecting sample tissue and/or cells. The brush is then withdrawn
through the cervix. The collected sample is smeared on a microscope
slide and analyzed.
Inventors: |
Suciu; Thomas N. (Tucson,
AZ), Schmidt; Herbert J. (Tucson, AZ) |
Assignee: |
Tucson Medical Instruments,
Inc. (Tucson, AZ)
|
Family
ID: |
25385024 |
Appl.
No.: |
05/884,634 |
Filed: |
March 8, 1978 |
Current U.S.
Class: |
600/569;
606/162 |
Current CPC
Class: |
A61B
10/0291 (20130101); A61B 2010/0216 (20130101); A61B
2017/00336 (20130101); A61B 2017/320012 (20130101) |
Current International
Class: |
A61B
10/00 (20060101); A61B 17/32 (20060101); A61B
17/00 (20060101); A61B 001/00 (); A61B
010/00 () |
Field of
Search: |
;73/425,425.2
;15/104.165,104.2,145,169,168,184,206
;128/2B,2N,269,DIG.14,256,357 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
|
|
|
|
|
|
671738 |
|
Sep 1929 |
|
FR |
|
2305959 |
|
Oct 1976 |
|
FR |
|
1394925 |
|
May 1975 |
|
GB |
|
Other References
Webster's Dictionary, G & C Merriam Co., Springfield, Mass.,
1963, p. 648, "plastic". .
"Expanded PTFE: It's A Whole New Ballgame", Plastics World, Jul.,
1971..
|
Primary Examiner: Michell; Robert W.
Assistant Examiner: Kruter; J. L.
Attorney, Agent or Firm: Cahill, Sutton & Thomas
Claims
What is claimed is:
1. An endometrial brush for obtaining endometrial samples, said
endometrial brush comprising in combination:
(a) a handle for manipulating said endometrial brush;
(b) a shaft having first and second end portions, the first end
portion being attached to said handle, said shaft being rigid and
bendable so that when said shaft is bent to a particular
configuration, said shaft rigidly retains that configuration;
(c) a plurality of bristles attached to the second end portion of
said shaft for collecting said endometrial sample, said bristles
being oriented about the second end portion of said shaft to form a
bristle section;
(d) a flexible sleeve slidably disposed on said shaft for covering
said bristles during insertion of said endometrial brush into a
patient's endometrium and exposing said bristles within the
endometrium to permit scraping of cells and tissue from the
endometrium by said bristles, said flexible sleeve having an
outside diameter sufficiently small to enable insertion of said
endometrial brush into the endometrium of the patient without
substantial discomfort to the patient;
(e) first means connected to said sleeve for effecting sliding said
sleeve along said shaft to cover said bristles during said
insertion and sliding of said sleeve along said shaft to expose
said bristles after said bristles are properly positioned in the
endometrium; and
(f) rounded means attached to the end of said shaft for minimizing
discomfort to the patient during insertion of said endometrial
brush, wherein said sleeve sealably engages said rounded means if
said sleeve is slid along said shaft so that one end of said sleeve
slides over said bristles and over said rounded means, whereby no
moisture, tissue, or cells contact said bristles during insertion
of said endometrial brush.
2. The endometrial brush of claim 1 wherein said first means
includes a flanged disc axially disposed on said shaft, said
flanged disc having a disc portion which is easily grasped by a
finger and thumb of the user of said endometrial brush, said
flanged disc also having a flange portion for engaging said
sleeve.
3. The endometrial brush of claim 1 wherein said sleeve is composed
of flexible material.
4. The endometrial brush of claim 3 wherein said sleeve has a
rounded edge to minimize discomfort to the patient during insertion
of said endometrial brush.
5. The endometrial brush of claim 1 wherein said handle is composed
of plastic.
6. The endometrial brush of claim 1 wherein said shaft is
detachable from said handle.
7. The endometrial brush of claim 1 wherein said shaft is composed
of brass tubing.
8. The endometrial brush of claim 1 wherein said bristles are
supported by a wound wire shaft having an end thereof attached to
the second end of said shaft.
9. The endometrial brush of claim 1 wherein said rounded means
includes a plastic bead.
10. The endometrial brush of claim 1 wherein said rounded means
includes a metal bead.
11. The endometrial brush of claim 1 wherein said bristles are
composed of synthetic nylon bristles.
12. The endometrial brush of claim 1 wherein:
(a) said bristles form a substantially cylindrical brush portion of
said endometrial brush, said cylindrical brush portion having a
diameter of approximately one fourth inch;
(b) said sleeve has an outside diameter of approximately 0.125
inches;
(c) said rounded means has an outside diameter of approximately
0.125 inches.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
The invention relates to brushes and methods for collecting sample
tissue from an endometrial cavity to aid diagnosing of endometrial
cancer.
2. Description of the Prior Art
For a number of years, the incidence of cervical cancer was greater
than the incidence of endometrial cancer. In order to diagnose
cervical cancer a reliable, inexpensive treatment, the well-known
Pap test, is widely utilized to diagnose cervical cancer. The Pap
test is widely accepted by physicians and patients because of its
reliability, low cost, convenience of application, and
painlessness. Patients are not hesitant to periodically submit to
the Pap test. Consequently, cervical cancer is usually diagnosed
sufficiently early to be effectively treated. As a result of such
effective treatment, the incidence of cervical cancer has become
smaller than the incidence of endometrial cancer. This has occurred
because until now, reliable, convenient, inexpensive, relatively
painless methods and devices for obtaining samples of endometrial
tissue and cells have not been available.
One known collecting device for endometrial cell and tissue
samples, called a Medoza Canula, includes a curved plastic stem to
facilitate its insertion into an endometrial cavity and a head
having annular plastic flanges which operate to scrape cells from
the walls of the endometrial cavity. The Medoza Canula includes a
retractable protective sleeve to cover the head and the plastic
flanges thereof to prevent wetting and contamination during
insertion of the device through the patient's cervix. Once the head
of the Medoza Canula is properly positioned in the endometrial
cavity, the protective sleeve is retracted, exposing the plastic
flanges. The handle is then manipulated forward and backward to
cause the plastic flanges to scrape cells and tissue from the walls
of the endometrial cavity. However, the Medoza Canula has a fixed
depth limiting member which limits the depth of penetration of the
head into the endometrial cavity. Consequently, for some patients
the plastic flanges do not reach sufficiently deeply into the
endometrial cavity to collect sample cells or tissue for analysis.
Another disadvantage of the Medoza Canula is that the plastic
flanges do not scrape the walls of the endometrial cavity
sufficiently effectively to collect all of the cells and tissue
which should be analyzed for presence of cancerous cells. The
plastic flanges do not effectively scrape loose tissue and cells in
response to rotation of the handle. Further, the plastic flanges
"pick up" loose cells, but do not effectively scrape or pick up
cells or tissue which is very deep within the endometrial walls.
This prevents analysis of a suitably broad spectrum of potentially
cancerous cells which might be present in the tissue of the
endometrial walls. Further, the adherance of scraped cells to the
plastic flanges of the Medoza Canula is thought to be inadequate to
ensure retention of such cells on the flanges during withdrawal of
the head through the cervix. Finally, the plastic flanges of the
Medoza Canula do not efficiently collect sample tissue and cells
from the deepest portions of the endometrial cavity. This is a
serious shortcoming, because endometrial cancer frequently begins
its growth in the deepest portions of the endometrial cavity.
Another known collecting device for endometrial cell and tissue
samples is disposed in U.S. Pat. No. 3,945,372, by Milan et al,
issued Mar. 23, 1976. The endometrial tissue obtaining instrument
described in the Milan et al patent includes a handle and a plastic
spiral section which is inserted into the endometrium and rotated
to collect endometrial tissue. This device does not have a
protective sleeve, as does the above Medoza Canula. It is believed
that the device of the Milan et al patent has the same general
shortcomings as the above-described Medoza Canula, and additionally
has the shortcoming that wetting of the spiral section occurs
during insertion, thereby substantially reducing the adherance of
endometrial tissue to the spiral section. It is also believed that
the spiral section does not dig sufficiently deeply into the
endometrial walls to collect as wide a spectrum of possibly
cancerous cells and tissues as is desirable.
Other methods of collecting endometrial cells and tissue include
aspirator type devices (which operate to suck cells from the
endometrial walls) and a type of device referred to as a "gravely
jet washer". Both of these types of devices require expensive motor
driven mechanisms. Such machines are not ordinarily available in a
physicians office. In both types of devices, the collected cells
are collected in a fluid, which must be strained through a filter
in order to collect the cells so that they can be placed on a
microscope slide by analysis. This type of procedure is not of a
type which can be economically routinely performed in a typical
physicians office.
It is an object of the invention to provide an inexpensive,
efficient method of obtaining samples of endometrial cells and/or
tissue.
It is another object of the invention to provide a method of
obtaining endometrial tissue and cell samples which can be easily
placed on a microscope slide for analysis.
It is another object of the invention to provide a method of
obtaining endometrial tissue which is sufficiently uncontaminated
to permit accurate diagnosis of endometrial cancer.
It is another object of the invention to provide an endometrial
brush which may be inserted with minimum discomfort to the
patient.
It is another object of the invention to provide an inexpensive
endometrial brush which efficiently collects a broad spectrum of
endometrial tissue and cell samples.
It is another object of the invention to provide an inexpensive
endometrial brush which avoids wetting and/or contamination of its
bristles during insertion and withdrawal of the endometrial
brush.
It is another object of the invention to provide an endometrial
brush to efficiently collect endometrial tissue and/or cell samples
from the deepest portions of an endometrial cavity.
Briefly described, and in accordance with one embodiment thereof,
the invention provides an endometrial brush and method for
efficiently and inexpensively collecting samples of endometrial
tissue and/or cells from the walls of a patient's endometrial
cavity. The endometrial brush includes a handle, which may be
permanently or detachably connected to a semi-rigid shaft. A
flexible, slidable sleeve is provided on the shaft and can be slid
forward along the shaft to cover the bristles of the brush during
insertion and withdrawal and can be slid backward along the shaft
to uncover the bristles in the endometrial cavity to permit
scraping of sample tissue and cells therefrom. The semi-rigid shaft
may be bent so that it conforms to the curvature of the passage
through the vagina, cervix, and endometrial cavity of an individual
patient. The shaft, when so bent, maintains its bent configuration
so that when the endometrial brush is fully inserted, the bristles
of the brush are suitably positioned for scraping and collecting
sample tissue and cells from the endometrial walls. The bristles
are helically wound to form a helix along a segment of the shaft
furthest from the handle. A small, rounded bead is connected to the
extreme end of the shaft beyond the bristles. The diameter of the
bead is sufficiently small to permit insertion of the endometrial
brush through the patient's cervix with minimum discomfort to the
patient. The bead forms a seal with the inner surface of the
flexible sleeve when the sleeve is slid forward to cover the
bristles during insertion and withdrawal of the endometrial brush.
In one embodiment of the invention, the rounded bead is omitted,
and a group of end bristles fanning outwardly from the end of the
shaft is provided to more efficiently scrape tissue and cell
samples from the deepest portions of the endometrial cavity, where
the probability of cancerous tissue and cells may be highest.
According to the invention, the slidable sleeve is deployed to
prevent the bristles from becoming "saturated" or wetted with
moisture and tissue from the vaginal canal and cervical passage
during insertion of the endometrial brush. After the bristles are
uncovered in the endometrial cavity, the handle of the endometrial
brush is then rotated and moved longitudinally to cause the
bristles to "dig into" the endometrial walls to scrape a broad
spectrum of cells and tissue therefrom. The sleeve is then deployed
to cover the bristles, the endometrial brush is then withdrawn, and
the sleeve is again retracted. The sample tissue and cells on the
bristles are then wiped onto a microscope slide for immediate
analysis. The endometrial brush may be discarded or sterilized for
later use. In one embodiment of the invention, the handle is
detachable from the shaft; the shaft and bristles thereof are
disposable.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of one embodiment of endometrial brush
of the invention.
FIG. 2A is a partial view of the bristle and shaft portion of the
endometrial brush of FIG. 1.
FIG. 2B is a perspective view of the bristle section of the brush
of FIGS. 1 and 2A illustrating the preferred helical nature of the
bristle section.
FIG. 3 is a diagram illustrating the protective sleeve partially
deployed to cover a portion of the bristles of the endometrial
brush of FIG. 1.
FIG. 4 is a partial view of endometrial brush of FIG. 1 showing the
protective sleeve deployed to entirely cover the bristle
section.
FIG. 5 is a sectional view taken along section lines 5--5 of FIG.
1.
FIG. 6 is a partial sectional view taken along section lines 6--6
of FIG. 1.
FIG. 7 is a partial sectional diagram taken along section lines
7--7 of FIG. 1.
FIG. 8 is a partial cutaway view showing an alternate bristle
configuration for the endometrial brush of FIG. 1.
FIG. 9 is a partial cutaway view showing a mechanism for permitting
removal of the shaft section from the handle section of the
endometrial brush.
FIG. 10A is a perspective view showing the configuration of the
endometrial brush with the shaft bent prior to the utilization.
FIG. 10B illustrates the shaft section bent with the sleeve
deployed to cover the bristle section and form a seal with the end
bead.
FIG. 11A illustrates insertion of the endometrial brush of FIG. 10A
into the cervical passage.
FIG. 11B illustrates deployment of the endometrial brush of FIG.
10A bristles exposed in the endometrium.
FIG. 12 illustrates rotation and longitudinal movement of the
endometrial brush to smear the collected endometrial sample on a
microscope slide.
DESCRIPTION OF THE INVENTION
Referring now to the drawings, and particularly to FIGS. 1-7,
endometrial brush 10 includes a handle 20, a slidable, flexible
sleeve 12 disposed about a rigid but bendable shaft 22, and a
cylindrical, preferrably helically wound, bristle brush 14 disposed
at the end of shaft 22. The helically wound bristles 14 are more
clearly illustrated in FIG. 2B. Sleeve 12 is manually slidable
along shaft 22 to expose or cover bristles 14 by means of flanged
disc 18, as indicated in FIGS. 1 and 7. The physician can slide
sleeve 12 forward by using the thumb and first digit of his hand
holding handle 20 to move disc 18 and sleeve 12 forward along shaft
22, as indicated by the arrow in FIG. 7, thereby covering bristles
14 and achieving a sealing relationship with rounded bead 16.
Sleeve 12 may be made of teflon. Handle 20 may be molded plastic.
Bristles 14 may be made of nylon or natural bristle, such as boar
bristle.
Bead 16 is disposed on the end of wound wire portion 24 of shaft
22. Rounded bead 16 sealably fits within the interior of flexible
sleeve 12 when sleeve 12 is slid forward as indicated in FIG. 4, so
as to protect bristles 14 from wetting and contamination of
bristles 14 by moisture and cervical tissue during insertion of
endometrial brush 10 through the cervix of a patient. Rounded bead
16 also prevents discomfort to the patient during the insertion of
endometrial brush 10 through the cervix and into the endometrial
cavity. Edge 17 of sleeve 12 is slightly rounded, as indicated by
reference numeral 17 in FIG. 4, to minimize discomfort to the
patient during insertion. Rounded bead 16 may be made of plastic or
other suitable material.
In a presently preferred embodiment of the invention the outside
diameters of helically wound bristle section 14 is slightly over
one fourth of an inch. The outside diameter of rounded bead 16 is
approximately 0.125 inches of an inch. The length of the section
including shaft 22 (but not any part of shaft 22 buried in handle
20) and bristles 14 is approximately seven inches; the length of
bristle section 14 is approximately one inch. Handle 20 is
approximately three and one half inches long. However, these
dimensions may be varied to suit varying requirements.
A wound wire shaft supporting bristles 14 is inserted into an open
end of shaft 22, which may be composed of metal tubing having an
outside diameter of approximately 0.093 inches and an inside
diameter of approximately 0.062 inches. FIG. 6 shows a
cross-sectional view of flexible sleeve 12, semi-rigid shaft 22,
and wound wire bristle-supporting shaft 24 taken along section
lines 6--6 of FIG. 1.
An alternate embodiment of the bristle section 14 is shown in FIG.
8, wherein a hemispherical end section 16' of bristles is provided
at the extreme end of the wound wire bristle supporting shaft in
place of rounded bead 16. The preferred helical winding of the
bristles 14 is illustrated in the perspective view of FIG. 2B. The
embodiment of FIG. 8 may be more desirable in certain cases for
probing the deepest portions of the endometrial cavity to collect
tissue and cell samples therefrom, but is somewhat more subject to
wetting and contamination during insertion of the endometrial brush
than the embodiment of FIGS. 1-4, and is more likely to cause
discomfort to the patient during insertion through the cervix.
As explained subsequently, it is desirable that shaft 22 be
semi-rigid, so that the physician can, after determining the
contour of the uterous of an individual patient, bend the shaft 22
so that it remains bent, as indicated in FIGS. 10A and 10B, to
facilitate scraping of tissue from the desired portions of the
walls of the endometrial cavity.
It is anticipated that the endometrial brush 10 of the present
invention will be most useful to physicians in furthering the art
of diagnosing endometrial cancer if the endometrial brush is
inexpensive and disposable, since the problems and inconvenience
associated with sterilizing and cleaning the endometrial brushes
after use is rather impractical and uneconomical in a typical
physician's office, where diagnosis of uterine cancer is ordinarily
preferably made. However, FIG. 9 discloses an alternate embodiment
of the invention having a disposable brush and shaft section and a
permanent handle section which can be removably engaged with the
disposable brush and shaft section. Alternately, the sleeve can be
discarded and the shaft and attached bristles can be cleaned,
sterilized, and re-used with a new sterile sleeve.
A graded scale is preferably provided on flexible sleeve 12, as
indicated in FIG. 1 by reference numerals 26, 27, and 28, so that
the physician can readily determine how far endometrial brush 10
has been inserted into the uterine cavity before the sleeve is
retracted to permit collecting of the tissue and cell sample. The
graded scale eliminates the need for the physician to initially
utilize a separate uterine sound to measure the uterus before
deploying the endometrial brush.
FIGS. 11A and 11B illustrate the insertion of a previously bent
endometrial brush (as indicated in FIG. 10A) through vagina 42 and
cervix 38 into endometrial cavity 40. FIG. 11A shows the rounded
bead portion of the endometrial brush about to enter cervix 38;
slidable sleeve 12 and flange disc 18 are in the forward position
so that a moisture-proof seal is provided between the end of
flexible sleeve 12 and rounded bead 38.
FIG. 11B shows the endometrial brush inserted into endometrial
cavity 40 with flexible sleeve 12 and optional flanged disc 18
retracted to expose bristles 14. The endometrial sample is then
collected.
Referring to FIGS. 11A and 11B, the method of utilizing endometrial
brush 10 to obtain accurate cytologic interpretation of the
endometrium is as follows. First, endometrial brush 10 is removed
from a sterile package. If a non-disposable handle is utilized, the
shaft and brush section is connected to the handle. Protective
sleeve 12 is then advanced over bristles 14 and rounded bead 16 to
protect bristles 14 from wetting and contamination during insertion
through the patient's cervix 38; a speculum can be utilized in the
usual manner.
Optionally, the cervix may be cleansed with an antiseptic solution.
Endometrial brush 10 is inserted through cervic 38 into the
endometrial cavity 40 until it reaches the fundal or top portion 48
of the uterus, whereat a slight resistance to further inward
movement of brush 10 is encountered.
The position of bristles 14 is maintained by holding handle 20
stationary and sliding protective sleeve 12 along the shaft toward
the handle by means of control disc 18, thereby exposing bristles
14 at the desired location within endometrial cavity 40.
An individual patient's cervix may be "tipped" either forward or
backward. Semi-rigid shaft 22 of endometrial brush 10 is therefore
bent in accordance with the contour of the individual patient's
uterous so that the sleeve, shaft, etc., may be inserted through
the cervix with minimum discomfort to that patient and so that
bristles 14 will be properly positioned when the insertion of the
endometrial brush is complete.
Handle 20 is then manipulated by rotating it and longitudinally
moving it so that the desired portions of the walls and fundal
portion of the endometrium are scraped by the helical bristles 14
to collect sample tissue and cells therefrom.
Endometrial brush 10 is then withdrawn straight out of the uterine
cavity, with the sleeve still advanced, as shown in FIG. 11B. In
most cases, it is preferable not to advance sleeve 12 over the
bristles 14 and rounded bead 16 prior to withdrawal of the
endometrial brush 10 because this would scrape much of the
collected cell and tissue sample off of bristles 14. Contamination
of the collected cell and tissue sample by cervical cells and
tissue during withdrawal ordinarily causes no difficulty, since
endometrial cancer cells are usually recognizably different than
cervical cancer cells. Since bristles 14 are already saturated by
endometrial cells and tissue at this stage of the method, very few
cervical cells will become affixed to the bristles during
withdrawal through the cervix. Withdrawal of the endometrial brush
10 usually causes very little discomfort to the patient, even with
bristles 14 exposed.
Bristles 14 are then smeared directly on glass slide 44 by rotating
the brush and streaking it longitudinally as indicated in FIG. 12.
This is a more convenient technique than that described in the
above Milan et al patent, and ensures a broad spectrum of the cells
and/or tissue collected from various parts of the endometrium are
available on the slide 44 for analysis. Glass slide 44 and sample
46 are then immediately placed in ninety-five percent alcohol
fixitive and submitted for staining by the well-known Papanicolau
technique. Further analysis is completely conventional, and will
not be described herein.
Adenocarcinoma of the endometrium is now accepted as the most
common female genital neoplasm. This change in relative frequency
between cervical cancer and endometrial cancer may be attributed to
several factors. Foremost among these factors has been the
development of cytologic screening techniques for cervical cancer,
widespread acceptance by physicians and patients of these
techniques, and their wide spread utilization in typical doctor's
offices.
The endometrial brush 10 disclosed herein should permit the
significant advances in the field of cytology and cytotechnology to
be applied to the interpretation of endometrial cytology by
providing adequate specimens for analysis. By using the foregoing
endometrial brush and method, endometrial specimens for analysis
may be readily collected on a routine basis. The simple and
reliable collecting technique involves minimal expense and
discomfort to the patient, and should meet with both physician and
patient acceptance.
The avoidance of wetting or saturation of the bristles of the
endometrial brush of the present invention during insertion thereof
through the cervix ensures that the bristles will be dry when
exposed. The dry bristles can scrape the desired cells and tissue
from the endometrial walls much more effectively than if the
bristles are wet. Well established procedures which are routine in
any gynecologist's or obstetrician's office are readily applicable.
The inconvenience and high cost of the aspirator type devices and
the gravely jet washer type devices previously used for collecting
endometrial tissue and cell samples are overcome by the present
endometrial brush and method of use. The helical bristles of the
inventive endometrial brush also are believed to scrape cells and
tissue from the endometrial walls, especially of the fundal portion
of the endometrium, more efficiently than the previously described
Medoza Canula, which has radial flanges or fins, and therefore must
be moved forward and backward in order to collect a sample. The
helical bristles are also believed to scrape cells from the
endometrial walls more efficiently than the device of the Milan et
al patent because the helical bristles individually dig into the
endometrial walls. It is further believed that the wetting of the
spiral section of the Milan et al device and the smoothness of the
entire spiral section thereof prevent adherence of the collected
endometrial sample to the degree that such adherence is achieved
for the helical bristles of the present invention.
Variations of the slidable protective sleeve are within the scope
of the present invention. For example, the protective sleeve may
have a closed end portion which is closed during insertion, and is
then opened by penetration of the end of the shaft and the bristles
thereon by sliding the protective sleeve toward the handle after
insertion into the endometrium. In another embodiment of the
invention, shaft 22 is flexible and sleeve 12 is semi-rigid. In
this case, the flexible shaft 22 is rotated within the semi-rigid
sleeve by means of the handle to cause the bristles to rotate
inside the endometrial cavity.
* * * * *